Ask Dr. Pane: Should I have a breast lift, reduction, augmentation or all of them?

Dr. Pane evaluates the options for a woman who is tired of her sagging breasts.

The Question

Atlantic Coast Aesthetics has helped thousands of clients to look and feel their best. For many women, the size, shape and appearance of their breasts is a major source of discomfort and dysphoria with their bodies. One common reason for this is known as “ptosis,” the technical term for sagging breasts. Ptosis may occur as a result of aging, breastfeeding, extreme weight loss and other factors. Our weekly Ask Dr. Pane segment is concerned with this question from a patient who writes, “I’ve had several children, and I miss the perkiness of my breasts. Do I need a lift, reduction, augmentation or a combination of all of them?”

The Case

The patient supplied photos, which Dr. Pane translated into a drawing. Based upon the photos, he observed a grade-three ptosis of her breast region, which means the ptosis is considered severe, with a moderate amount of breast volume. This sort of ptosis is characterized by an elongated vertical breast profile in which the nipples and aureoles point toward the ground.

Dr. Pane’s Answer

Given the patient’s condition, Dr. Pane believes at a minimum a breast lift and reduction may be appropriate. The lift is necessary to revise the breast tissue upward and regain the “perky” profile the patient is seeking, while reduction of the breast volume may be helpful in ensuring the results are maintained over time. The procedure to correct severe ptosis typically requires a longer lateral incision at the base of the breast and a further incision along the breast’s underside, culminating at or just before the aureole. Scarring is normal and can be minimized, but not wholly avoided, so some patients may prefer not to go this route.

Dr. Pane notes that the other primary question concerns whether the patient wants to undergo breast augmentation with implants to make up some of the volume of the breasts. Some patients may wish to skip this step, sacrificing breast volume through a reduction procedure in favor of more aggressive sculpting and contouring of the area. In some cases, low-volume implants may be helpful to preserve the bust profile and help prevent flatness of the upper slope of the breast resulting from the forcible rearrangement of the existing internal tissue. A great deal depends on the patient’s intended and desired outcomes, as well as her specific medical history, whether she is completely done with having children and her general physical health.

As usual, Dr. Pane cautions that the only way to create a proper, specific treatment plan for any given patient or condition is to evaluate the patient’s current condition in a clinical setting and determine what the best way to proceed is. In the case of aggressive surgical intervention for ptosis, Dr. Pane notes that scarring is an unavoidable part of this procedure. Patients should be extremely wary of providers who claim they can correct ptosis without scars, because the sheer amount of surgical intervention required to correct ptosis and restore a more youthful bust is simply not able to be achieved any other way at this time.

Cosmetic surgery has improved by leaps and bounds just in the last decade, and new techniques and procedures are being explored every day. However, there are some conditions which simply do not lend themselves well to less-invasive corrective measures. It is in the patient’s best interests to work with their chosen cosmetic surgeon to thoroughly evaluate, discuss and choose a procedure which offers the best balance between the desired outcome and the limitations of the human body and modern cosmetic surgery. This helps ensure the anticipated results are realistic and minimizes the chances of dissatisfaction with the outcome later. Observing good aftercare protocols can also go a long way toward reducing the likelihood of issues arising from cosmetic surgery.

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Atlantic Coast Aesthetics believes patient education and advocacy is the first step in assuring the best possible outcome for all our patients. That’s why we encourage you to reach out to us with any cosmetic surgery-related questions you may have. You can follow us on Facebook and Twitter, email us at or call us at (561) 422-4116. Your question may even be the focus of an upcoming Ask Dr. Pane segment, allowing us to help you and others who have the same questions, concerns and interests you do. Remember, at ACA we believe the only bad question is the one you don’t ask!


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